Having considerable experience with, and an equal measure of interest in, both depression and addiction, i've been mulling over (pun intended) the convergence of two modern treatment approaches, one for addiction and one for depression.

The one for addiction, as far as i know, doesnt have a formal name but it is based on explaining addiction and by extension curing it through changes in the subject's environment. This comes out of Bruce Alexander's rat studies in the 1970s. This is his website with an analysis of what he did...

Johann Hari, in his book Chasing the scream: the first and last days of the war on drugs takes up the approach through various case studies including vietnam vets, medical outcomes for patients exposed to prolonged heavy pain relief drugs and the environment orientated approach to drug use currently adopted in Portugal. A nice synopsis of it is here from the Huffington Post

Basically, the idea is that addiction can be overcome through a positive change in the environment that incorporates meaningful work, group interaction and real social bonding and participation.

The approach to depression i'm interested in comes out of the University of Kansas' department of psychology and is called Therapeutic Lifestyle Change (TLC). The main researcher is professor Stephan Ilardi and in typical American style he has a...'6 step program' and a book to go with it! Now, for me, thats straight away a big turn off but the six 'steps' are just lifestyle changes that dont ring of woo to me. You can go to the Uni's website for full details http://tlc.ku.edu/background ...but i'll list them here in case you cant be arsed.

1. Diet rich in Omega-3 (This could be woo, not sure of the evidence here)
2. Rumination prevention strategies
3. Exercise (extrapolated to meaningful activity, with other people and not just working out at home on your own)
4. Light Therapy (LT) - i know, i know woooo but there is this justification

Quote:

Prescribed to treat a host of conditions, light therapy (LT), or phototherapy, consists of exposure to daylight or artificial bright light for a determined period of time at a specific time of day. Early intervention research targeted seasonal affective disorder (SAD) with the first published study by Rosenthal and colleagues (1984). A meta-analysis by the American Psychiatric Association Committee on Research on Psychiatric Treatments (Golden et al., 2005), using strict criteria for only the most methodologically sound trials, concluded that LT is superior to placebo in reducing symptoms of seasonal affective disorder, with an effect size of 0.84. In fact, remission rates were found to be nearly three times higher (Odds Ratio of 2.9) among LT patients in comparison with those receiving placebo. Likewise, when limiting their evaluation to the most methodologically sound studies, Golden and colleagues found that LT was an effective stand-alone treatment for nonseasonal depression, with an effect size of 0.53. They also noted that this observed effect size is similar to that of most antidepressant medication trials.

A Cochrane meta-analysis (Tuunainen, Kripke, & Endo, 2004) examining the effect of LT on nonseasonal depression found that treatment response was significantly better in the LT group compared to the control treatment group (18 studies, 505 patients). This finding was mainly due to the significant benefit of short term treatment of seven days or less (12 studies, 367 patient). Medium term treatment did not show any significant superiority of bright light (6 studies, 138 patients). However, due to significant heterogeneity a more conservative statistical model was also employed and the study effects were no longer statistically significant.

...basically go outside more, get some fucking sun!

5. Social bonds
6. Healthy sleep patterns

There are many possible objections to TLC but you have to remember that there is no magic bullet for depression but an array of weapons that sufferers can deploy as appropriate to their taste and particular circumstances and i feel that the TLC method, or parts thereof, may as well be one of them and indeed that is Ilard's claim - do whatever you can, try some of these.

What i find interesting is the convergence of TLC with the new approach to understanding addiction. For both, the importance of social bonding is paramount. In Hari's book he talks about a group of former addicts who start a removals business together which creates a social, and i guess in this case a commercial, bond but the nature of the work would mean that the LT aspect would be satisfied along with exercise. Importantly, i've dug deep down into my early twenties draw to retrieve my Karl Marx wand in order to magically invoke him, the work is meaningful!

The TLC approach is strong on maximising 'face time' with friends and loved ones, that is actual physical time together as opposed to our modern tendency toward 'screen time' (as i type). This also has a distractive quality that obviates negative rumination. And this i would suggest is perfectly compatible with our understanding of addiction remembering that addiction becomes a sublimated loved one, a distraction from rumination and indeed isolation (youre not isolated because you have your loved one whichever intoxicant it may be) and an impermanent escape from the Skinners isolated rat cage.

So in summary, ameliorating (and i wont say 'curing' because its not about that) the destructive and negative qualities of both addiction and depression may involve the same course of action. The problem is that the nature of modernity in developed cities makes the course of action increasingly difficult to undertake. So i'll now dig into my early twenties draw again, wack my headband on and head off to Nimbin for some meaningful gardening.

Music 'therapy' seems to help with my fluctuating depression, in addition to exercise and social interaction. Not sure if there's science behind music therapy though

__________________
“It's not my responsibility to be beautiful. I'm not alive for that purpose. My existence is not about how desirable you find me.” ― Warsan shire
“Human beings have rights and are entitled to respect. Ideas, books, and beliefs don’t, and aren’t.” ― Ali A Rizvi

Professionals are too intellectual about mental health. I went to a psychologist this week who kept talking with pride about how "rational" she is. What the fuck? You are dealing with people and their suffering! It is not science! Mental illness is an emotional disorder. Treating symptoms and socialising people will never work. It is wrong, wrong, wrong and I could not give a rats what they teach at university because it is wrong! I will make my own thread about depression soon for people who are interested in alleviating their suffering, not their careers.

Professionals are too intellectual about mental health. I went to a psychologist this week who kept talking with pride about how "rational" she is. What the fuck? You are dealing with people and their suffering! It is not science! Mental illness is an emotional disorder. Treating symptoms and socialising people will never work. It is wrong, wrong, wrong and I could not give a rats what they teach at university because it is wrong! I will make my own thread about depression soon for people who are interested in alleviating their suffering, not their careers.

It is not just about careers, but general quality of life. I am sure that most professionals do care about the suffering. If one wanted to make a shit-load of money, one would NOT choose the public mental health services as a career cash-cow. In my experience such workers are very over-worked and underpaid. Most are incredibly dedicated and caring.
But no amount of caring or empathy will cure a mental illness, or help to manage it. That is not to say that caring is unimportant, because it is.
I am the carer and guardian of a person suffering from schizophrenia. Schizophrenia is an extremely complex condition to understand. Over 100 genes and their variations and expression [some of which may be also subject to epigenetic variations] are implicated. At present, the disease can only be managed to some degree, and at present is incurable.
And yes, mental illnesses,as well as being expensive to manage and treat, cause a loss of productivity. That does not change the fact that people [including professionals] really do care about the suffering such diseases cause on a personal level to people who suffer from them, including the risks of physical injury and even death in many cases.
The good thing that is happening is that hope, more qualified, is emerging about better treatments and even cures for many of these illnesses. As medical sciences increase their understanding, the closer we are getting to managing and even curing such diseases more effectively.
A surgeon has the option of crying in horror at a child's broken body, or she can focus on the job and do life-saving surgery to restore the child to health.
And the mental health professional's main job is to use their medical knowledge to try and treat and support those with mental issues. Empathy/caring is only a part of that process. If a person has an issue with any particular health worker, then they can request to be treated by someone else.

__________________
Just stick to the idea that science tests falsifiable hypotheses to destruction.

Professionals are too intellectual about mental health. I went to a psychologist this week who kept talking with pride about how "rational" she is. What the fuck? You are dealing with people and their suffering! It is not science! Mental illness is an emotional disorder. Treating symptoms and socialising people will never work. It is wrong, wrong, wrong and I could not give a rats what they teach at university because it is wrong! I will make my own thread about depression soon for people who are interested in alleviating their suffering, not their careers.

Well, i think there is some science behind many mental disorders in terms of neurology and neurotransmitters as well as other chemical imbalances. SSRIs have a very good success rate for example, way better than placebos.

Mental illness can be an emotional disorder but you're heading down a slippery scientific and medical path if you're really going to claim 'all' mental disorders are emotional. Its a claim you'd need to support with some evidence i'd have thought.

As for depression, its a mysterious beast that we are only just starting to get a clearer picture of and it seems to me that different approaches work for different people. With respect I advise you not to go around saying that this or that treatment will fix depression, its neither fair on the person you're speaking to nor is necessarily accurate.

If you didnt like the psychologist you went to try another. They are not all the same.

And there is another aspect of "mental illness degrades productivity". People who actually care about other people's problems can sell funding for more medical and psychological services and research on the basis of "productivity" to greedy business people or tight-fisted governments. The "side-benefit" for the mental health services consumer is the likelihood of better and more treatment, scientific advances etc. Perhaps even paying medical staff more or giving them more time per patient [by employing more health workers] so that they can have time to take a breath, and the energy to express the caring side of their natures?

__________________
Just stick to the idea that science tests falsifiable hypotheses to destruction.